Beta-Blockers in Prevention of Development of Varices and Variceal Bleeding in Cirrhosis: Current Management, Controversies, and Future Directions

Abstract

One of the major complications of cirrhosis is the development of portal hypertension and variceal bleeding. Varices develop at a rate of 5% per year with a 10-year cumulative incidence of 44%. 1 Variceal bleeding accounts for 10% of all admissions with gastrointestinal bleeding; it has an inpatient mortality of 15% and a 1-year mortality of ≥40%. 2 Therefore, reducing the risk of the development of varices (pre-primary prophylaxis) and the first variceal bleed (primary prevention) are important clinical goals. Non-selective beta-blockers (NSBBs) have been used to reduce portal pressure and variceal bleeding for >35 years. There are several key mechanisms in the pathophysiology of portal hypertension in cirrhosis, namely increased intrahepatic resistance, splanchnic vasodilation, and augmented blood flow, that result in the hyperdynamic circulation. 3